Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2690 | MA |
Y | 213ES0000X | Sports Medicine | 2690 | MA |
NPI | 1417615162 |
---|---|
Provider Name | Samuel Obrien |
First Address | Newton, MA 02458-1264 |
Second Address | Newton, MA 02458-1264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2021 |
Last Update Date | 30/11/2021 |